Healthcare Provider Details

I. General information

NPI: 1528853041
Provider Name (Legal Business Name): COLLIER THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 W CENTRAL AVE STE 106
WICHITA KS
67212-6302
US

IV. Provider business mailing address

428 S STONEY POINT ST
WICHITA KS
67209-3524
US

V. Phone/Fax

Practice location:
  • Phone: 316-945-5200
  • Fax:
Mailing address:
  • Phone: 229-630-1798
  • Fax: 615-658-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JERYN COLLIER
Title or Position: OWNER/PROVIDER
Credential: LMFT
Phone: 229-630-1798